Severe Lung Illness Associated with E-Cigarettes and Vaping

Background

The Maryland Department of Health is investigating cases of individuals who have developed severe lung illness with no clear infectious cause after using e-cigarettes, or “vaping.” Similar cases have been reported in other states across the United States. 

Cases of Vaping-Associated Lung Illness (as of September 10, 2019)15

Symptoms of Vaping-Associated Lung Illness

Patients report using e-cigarettes or vaping in the weeks or months prior to the onset of symptoms. Respiratory symptoms reported include: shortness of breath, chest pain, pain on breathing, wheezing, cough, and coughing up blood. Other symptoms reported by many patients include: fever, chills, nausea, weight loss, vomiting, diarrhea, or abdominal pain.


Detailed descriptions of this illness, and clinical guidance that may aid identification, can be found in recent publications in the New England Journal of Medicine and Morbidity and Mortality Weekly Report.


Causes of Vaping-Associated Lung Illness

The cause of this cluster of illnesses is not known, and has not been definitively linked to any particular device, substance, or brand. People who became ill reported using a range of products, including both cannabis-derived products with THC or CBD, and nicotine-containing products


Frequently Asked Question for the Public

Q: What are e-cigarettes? What is vaping?

A: E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals. Users inhale the aerosol, including any additives, into their lungs. Commonly inhaled chemicals include nicotine, tetrahydrocannabinol (THC, the psychoactive component in cannabis/marijuana), cannabidiol (CBD, another chemical found in cannabis/marijuana), flavorings, and other additives like propellants, solvents, and oils. Vaping means using these products.

Q: How can I keep myself safe from vaping-associated lung illness?

A: The best way to keep yourself safe is to not use e-cigarettes or vapes.

Q: I want to quit using e-cigarettes and vaping but I can’t. What should I do?

A: If you want to stop using e-cigarettes, or any tobacco product, you can call the Quitline at 1-800-QUIT-NOW: Trained professionals are there 24/7 to help you.

Q: I used e-cigarettes to help me quit smoking. What should I do?

A: Don’t start smoking again. There are several FDA-approved quit aids like nicotine patches, gum, or lozenges that safely help smokers quit and reduce nicotine withdrawal. Use these products instead of vaping to help you stay quit. FDA-approved quit aids can be mailed to you for free through the Quitline (see above), or by your local health department.

Q: I heard this illness is caused by marijuana or THC oils. Is that true?

A: We do not know yet what causes this illness. Many, but not all, patients who developed this illness report that, in addition to nicotine, they vaped pre-filled cartridges of cannabis-derivative products like THC or CBD. Maryland Department of Health strongly advises against the use of these products.

Q: I heard this illness is caused by Vitamin E. Is that true?

A: We do not know yet. Testing at several national labs has identified a compound – vitamin E acetate – in some, but not all, of the THC product samples collected from people who became sick. However, we do not know if Vitamin E acetate was the cause, or even one of several causes, of the illness. There is also no way for you to test if a product you purchase contains vitamin E acetate or any other possibly harmful chemical.

Q: I only use THC or CBD oils made with natural ingredients and safe extraction techniques that come in sealed cartridges. Is that safe?

A: No product has yet been identified as safe, and there is no evidence to date that any set of ingredients or extraction techniques prevent this illness. Additionally, information about ingredients or extraction techniques listed on packaging may not be accurate. Ingredients that may be safe when eaten or applied to skin may not be safe when vaporized or inhaled.

Q: Where can I learn more about the health-effects of vaping?

A: The Maryland Department of Health has a website for youth and young adults – www.TheVapeExperiment.com – that describes the known and unknown hazards associated with vaping and e-cigarette use.

Q: I’m enrolled in Maryland’s medical cannabis program. Should I stop or change what I’m using?

A: Persons enrolled in Maryland’s medical cannabis program who vape and are concerned about this illness can contact their medical provider to discuss the risks and benefits of the products they are using. If you start to experience any of the symptoms listed above, seek immediate medical attention. If you think you became sick because of medical cannabis, you should report the incident by e-mail to reporting.mmcc@maryland.gov.


Information for the Public

MDH Center for Tobacco Prevention and Control
Maryland Tobacco Quitline

FDA, Center for Tobacco Products
Know the Risks: E-cigarettes and Young People

CDC: Smoking and Tobacco Use

The Vape Experiment


Information for Clinicians

**NEW** NEJM Preliminary Report

**NEW** MMWR CDC Interim Guidance

MDH Clinician Letter on Vaping and Lung Injury

MDQuit Resource Center

CDC Clinical Outreach Alert 

​​